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carbohydrate\tevery\t1-2\thr\t(or\t50\tg\tof\tcarbohydrate\tevery\t3-4\thr)\tis\tusually\tsufficient.\n5.\t\nThe\thealth\tcare\tteam\tshould\tbe\tcalled\tif\tillness\tcontinues\tfor\tmore\tthan\t1\tday.\nAdapted\tfrom\tKaufman\tF:\t\nMedical\tmanagement\tof\ttype\t1\tdiabetes\n,\ted\t6,\tAlexandria,\tVA,\t2012,\tAmerican\nDiabetes\tAssociation.\nFasting
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] |
to\t3\tam)\tthan\tat\tdawn\t(from\t4\tam\tto\t8\tam).\tThe\tincreased\tneed\tfor\tinsulin\tat\tdawn\tcauses\ta\trise\tin\nFBG\tlevels\treferred\tto\tas\tthe\t\ndawn\tphenomenon\n.\tIt\tresults\tif\tinsulin\tlevels\tdecline\tbetween\npredawn\tand\tdawn\tor\tif\n\tovernight\thepatic\tglucose\toutput\tbecomes\texcessive\tas\tis\tcommon\tin\tT2DM.
|
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] |
To\tidentify\tthe\tdawn\tphenomenon,\tblood\tglucose\tlevels\tare\tmonitored\tat\tbedtime\tand\tat\t2\tam\tto\t3\nam.\tWith\tthe\tdawn\tphenomenon,\tpredawn\tblood\tglucose\tlevels\twill\tbe\tin\tthe\tlow\trange\tof\tnormal\tbut\nnot\tin\tthe\thypoglycemic\trange.\tFor\tpatients\twith\tT2DM,\tmetformin\toften\tis\tused\tbecause\tit\ndecreases\thepatic\tglucose\toutput.\tFor\tpersons
|
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] |
decreases\thepatic\tglucose\toutput.\tFor\tpersons\n\twith\tT1DM,\tadministering\tinsulin\tthat\tdoes\tnot\tpeak\nat\t1\tam\tto\t3\tam,\tsuch\tas\ta\tlong-acting\tinsulin,\tshould\tbe\tconsidered.\nHypoglycemia\tfollowed\tby\trebound\thyperglycemia\tis\tcalled\tthe\t\nSomogyi\teffect\n.\tThis\tphenomenon
|
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] |
Somogyi\teffect\n.\tThis\tphenomenon\noriginates\tduring\thypoglycemia\twith\tthe\tsecretion\tof\tcounterregulatory\thormones\t(glucagon,\nepinephrine,\tgrowth\thormone,\tand\tcortisol)\tand\tusually\tis\tcaused\tby\texcessive\texogenous\tinsulin\ndoses.\tHepatic\tglucose\tproduction\tis\tstimulated,\tthus\traising\tblood\tglucose\tlevels.\tIf\trebound
|
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0.05521656572818756,
0.12419482320547104,
0.12723836302757263,
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] |
hyperglycemia\tgoes\tunrecognized\tand\tinsulin\tdoses\tare\tincreased,\ta\tcycle\tof\toverinsulinization\tmay\nresult.\tDecreasing\tevening\tinsulin\tdoses\tor,\tfor\tthe\tdawn\tphenomenon,\ttaking\ta\tlong-acting\tinsulin\nshould\tbe\tconsidered.\nLong-term\tcomplications
|
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] |
Long-term\tcomplications\tof\tdiabetes\tinclude\tmacrovascular\n\tdiseases,\tmicrovascular\tdiseases,\tand\nneuropathy.\t\nMacrovascular\tdiseases\n\tinvolve\tdiseases\tof\tlarge\tblood\tvessels.\tIn\tcontrast,\nmicrovascular\tdiseases\n\tassociated\twith\tdiabetes\tinvolve\tthe\tsmall\tblood\tvessels\tand\tinclude\nnephropathy\tand\tretinopathy.
|
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] |
nephropathy\tand\tretinopathy.\nCommon\tconsequences\tof\tdiabetic\tneuropathy\tand/or\tperipheral\tarterial\tdisease\t(PAD)\tinclude\nfoot\tulcers\tand\tamputation,\tand\tboth\trepresent\tmajor\tcauses\n\tof\tmorbidity\tand\tmortality\tin\tpeople\nwith\tdiabetes.\tEarly\tdetection\tis\tkey\tin\ttreatment\tof\tpatients\twith\tdiabetes\tand\tfeet\tat\trisk\tfor\tulcers
|
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] |
and\tamputations.\tRisk\tfactors\tinclude\tpoor\tglycemic\tcontrol,\tperipheral\tneuropathy\twith\tloss\tof\nprotective\tsensation\t(LOPS),\tcigarette\tsmoking,\tfoot\tdeformities,\tpreulcerative\tcallus\tor\tcorn,\tPAD,\nhistory\tof\tfoot\tulcer\tor\tamputation,\tvisual\timpairment,\n\tand\tdiabetic\tkidney\tdisease\t(especially\npatients\ton\tdialysis)\t(\nADA,\t2018\n).
|
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patients\ton\tdialysis)\t(\nADA,\t2018\n).\nMNT\tis\timportant\tin\tmanaging\tseveral\tlong-term\tcomplications\tof\tdiabetes.\tNutrition\ttherapy\tis\nalso\ta\tmajor\tcomponent\tin\treducing\trisk\tfactors\tfor\tchronic\tcomplications,\tespecially\tthose\trelated\tto\nmacrovascular\tdisease.\nMacrovascular\tdiseases
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] |
macrovascular\tdisease.\nMacrovascular\tdiseases\nInsulin\tresistance,\twhich\tmay\tprecede\tthe\tdevelopment\tof\tT2DM\tand\tmacrovascular\n\tdisease\tby\nmany\tyears,\tinduces\tnumerous\tmetabolic\tchanges\tknown\tas\tthe\t\nmetabolic\tsyndrome\n\t(see\t\nChapter\n20\n).\tIt\tis\tcharacterized\tby\tintraabdominal\tobesity\tor\tthe\tandroid\tdistribution\tof\tadipose\ttissue\t(waist
|
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] |
circumference\tgreater\tthan\t102\tcm\t[40\tin]\tin\tmen\tand\tgreater\tthan\t88\tcm\t[35\tin]\tin\twomen)\tand\tis\nassociated\twith\tdyslipidemia,\thypertension,\tglucose\tintolerance,\tand\tincreased\tprevalence\tof\nmacrovascular\tcomplications.\tOther\trisk\tfactors\tinclude\tgenetics,\tsmoking,\tsedentary\tlifestyle,\thigh-\nfat\tdiet,\trenal\tfailure,\tand\tmicroalbuminuria.
|
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fat\tdiet,\trenal\tfailure,\tand\tmicroalbuminuria.\nMacrovascular\tdiseases\tincluding\tatherosclerotic\tcardiovascular\tdisease\t(ASCVD),\tperipheral\nvascular\tdisease\t(PVD),\tand\tcerebrovascular\tdisease\tare\tmore\tcommon,\ttend\tto\toccur\tat\tan\tearlier\nage,\tand\tare\tmore\textensive\tand\tsevere\tin\tpeople\twith\tdiabetes.\n\tPeople\twith\tdiabetes\thave\tthe\tCVD
|
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0.08533087372779846,
0.09544306248426437,
0.09141828864812851,
0.0035849090199917555
] |
People\twith\tdiabetes\thave\tthe\tCVD\nrisk\tequivalent\tto\tpersons\twith\tpreexisting\tCVD\tand\tno\tdiabetes\t(\nLow\tWang\tet\tal,\t2016\n).\nFurthermore,\tin\twomen\twith\tdiabetes\tthe\tincreased\trisk\tof\tmortality\tfrom\theart\tdisease\tis\tgreater\nthan\tin\tmen,\tin\tcontrast\tto\tthe\tnondiabetic\tpopulation,\tin\twhich\theart\tdisease\tmortality\tis\tgreater\tin\nmen\tthan\tin\twomen\t(
|
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] |
men\tthan\tin\twomen\t(\nRecarti\tet\tal,\t2015\n).\nDyslipidemia\nPatients\twith\tdiabetes\n\thave\tan\tincreased\tprevalence\tof\tlipid\tabnormalities\tthat\tcontribute\tto\thigher\nrates\tof\tCVD.\tFor\texample,\tin\tT2DM\tthe\tprevalence\tof\tan\televated\tcholesterol\tlevel\tis\tabout\t28%\tto
|
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] |
34%.\tSimilarly,\tabout\t5%\tto\t14%\tof\tpatients\twith\tT2DM\thave\thigh\ttriglyceride\tlevels.\tLower\tHDL\ncholesterol\tlevels\tare\tcommon.\tPeople\twith\tT2DM\ttypically\thave\tsmaller,\tdenser\tLDL\tparticles,\nwhich\tincrease\tatherogenicity\n\teven\tif\tthe\ttotal\tLDL\tcholesterol\tlevel\tis\tnot\tsignificantly\televated.
|
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] |
Lifestyle\tintervention,\tincluding\tMNT,\talong\twith\tweight\tloss\t(if\tindicated)\tthrough\treduced\tenergy\nintake\tand\tincreased\tphysical\tactivity\tand\tsmoking\tcessation\tshould\tbe\tconsidered.\tEvidence\tis\ninconclusive\tfor\tthe\tideal\tamount\tof\ttotal\tfat\tintake;\tfat\tquality\tmay\tas\timportant\tas\tquantity\t(\nEvert\net\tal,\t2013\n).\tDiet\tshould\tbe
|
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Evert\net\tal,\t2013\n).\tDiet\tshould\tbe\n\tfocused\ton\treduction\tof\tsaturated\tfat,\ttrans\tfat,\tand\tcholesterol\tand\nincreased\tintake\tof\tomega-3\tfat\t(in\tfood,\tnot\tas\tsupplements),\tviscous\tfiber,\tand\tplant\tstanols/sterols\n(\nADA,\t2018\n).\tIn\tpeople\twith\tT2DM,\ta\tMediterranean-style,\tMUFA-rich\teating\tpattern\tmay\tbenefit
|
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] |
glycemic\tcontrol\tand\tCVD\trisk\tfactors.\tOther\tCVD\tnutrition\trecommendations\tfor\tpeople\twith\ndiabetes\tare\tthe\tsame\tas\tfor\tthe\tgeneral\n\tpublic.\tThe\tmost\tcurrent\tAmerican\tCollege\tof\tCardiology\n(ACC)/American\tHeart\tAssociation\t(AHA)\trecommendations\tare\tfor\tuse\tof\tthe\tDASH\tdiet\teating\npattern\t(see\t\nChapter\t32
|
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] |
pattern\t(see\t\nChapter\t32\n).\tIn\taddition\tto\tnutrition\ttherapy,\tstatin\ttherapy\tis\ttypically\trecommended,\nregardless\tof\tlipid\tlevels,\tfor\tall\tadults\tover\t40\twith\tdiabetes\t(\nADA,\t2018\n)\t(\nTable\t29.9\n).\nTABLE\t29.9\nRecommendations\tfor\tLipid\tand\tBlood\tPressure\n\tfor\tMost\tAdults\tWith\tDiabetes\nLipids/Blood\tPressure\nCriteria\nLDL\tcholesterol
|
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] |
Lipids/Blood\tPressure\nCriteria\nLDL\tcholesterol\n<100\tmg/dL\t(<2.6\tmmol/l)\n*\nHDL\tcholesterol\nMen:\t>40\tmg/dL\t(>1.0\tmmol/l)\nWomen:\t>50\tmg/d\t(>1.3\tmmol/l)\nTriglycerides\n<150\tmg/dL\t(<1.7\tmmol/l)\nBlood\tpressure\n<140/90\tmm\tHg\n*
|
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-0.042351532727479935,
-0.03140293434262276,
-0.06606984883546829,
-0.017985239624977112,
-0.051599711179733276,
0.02288394793868065,
-0.034497253596782684,
-0.05721528083086014,
-0.029715023934841156,
0.03953605145215988,
0.08804803341627121,
0.059352025389671326
] |
Triglycerides\n<150\tmg/dL\t(<1.7\tmmol/l)\nBlood\tpressure\n<140/90\tmm\tHg\n*\nFor\tpatients\twith\tdiabetes\tand\tatherosclerotic\tcardiovascular\tdisease,\tif\tLDL\tcholesterol\tis\tgreater\tthan\tor\tequal\tto\t70\tmg/dL\ton\tmaximally\n\ttolerated\nstatin\tdose,\tconsider\tadding\tadditional\tLDL\tlowering\ttherapy\t(such\tas\tezetimibe\tor\tPCSK9\tinhibitor).\nHDL
|
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0.0735512375831604,
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0.006405763793736696,
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0.011161698959767818,
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0.07010071724653244,
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0.07332004606723785,
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0.014823557808995247,
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0.010210493579506874,
0.023999039083719254,
0.07926513999700546,
0.01722298376262188
] |
HDL\n,\tHigh-density\tlipoprotein;\t\nLDL\n,\tlow-density\tlipoprotein.\nData\tfrom\tAmerican\tDiabetes\tAssociation:\tCardiovascular\tdisease\tand\trisk\tmanagement:\tStandards\tof\tmedical\tcare\tin\tdiabetes—2018,\t\nDiabetes\nCare\n\t41(S1):S86-104,\t2018.\nHypertension\nHypertension\tis\ta\tcommon\tcomorbidity\tof\n\tdiabetes,\twith\tabout\t74%\tof\tadults\twith\tdiabetes\thaving
|
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diabetes,\twith\tabout\t74%\tof\tadults\twith\tdiabetes\thaving\nblood\tpressure\tof\t140/90\tmm\tHg\tor\thigher\tor\tusing\tprescription\tmedications\tfor\thypertension\t(\nCDC,\n2018\n).\tIn\torder\tto\treduce\tthe\trisk\tof\tmacrovascular\tand\tmicrovascular\tdisease,\ttreatment\tof\nhypertension\tin\tpeople\twith\tdiabetes\tshould\tbe\tvigorous.\tBlood\tpressure\tshould\tbe\tmeasured\tat
|
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every\troutine\tvisit,\twith\ta\tgoal\tfor\tblood\tpressure\tcontrol\n\tof\tless\tthan\t140/80\tmm\tHg.\tMNT\ninterventions\tfor\tpeople\twith\thypertension\tinclude\tweight\tloss\t(if\toverweight),\tDASH-style\teating
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] |
pattern\t(\nAppendix\t17\n),\treducing\tsodium\tintake\tand\tincreasing\tpotassium\tintake,\tmoderation\tof\nalcohol\tintake,\tand\tincreased\tphysical\tactivity\t(see\t\nChapter\t32\n).\tThe\trecommendation\tfor\tthe\tgeneral\npopulation\tto\treduce\tsodium\tto\tless\tthan\t2300\tmg/day\tis\talso\tappropriate\n\tfor\tpeople\twith\tdiabetes\nand\thypertension\t(\nADA,\t2018
|
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] |
for\tpeople\twith\tdiabetes\nand\thypertension\t(\nADA,\t2018\n).\tFor\tindividuals\twith\tboth\tdiabetes\tand\thypertension,\tfurther\nreduction\tin\tsodium\tintake\tshould\tbe\tindividualized.\tConsideration\tmust\tbe\tgiven\tto\tissues\tsuch\tas\nthe\tavailability,\tpalatability,\tand\tadditional\tcost\tof\tlow\tsodium\tfood\tproducts.\tPharmacologic\ttherapy
|
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0.05626782774925232,
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] |
for\thypertension\tincludes\teither\tan\tangiotensin-converting\tenzyme\t(ACE)\tinhibitor,\n\tangiotensin\nreceptor\tblockers,\tthiazide-like\tdiuretics,\tand/or\tdihydropyridine\tcalcium\tchannel\tblockers\t(\nADA,\n2018\n).\tSee\t\nTable\t29.9\n.\nMicrovascular\tdiseases\nDiabetic\tkidney\tdisease
|
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] |
).\tSee\t\nTable\t29.9\n.\nMicrovascular\tdiseases\nDiabetic\tkidney\tdisease\nDiabetic\tkidney\tdisease\t(DKD)\tor\tdiabetic\tnephropathy\toccurs\tin\t20%\tto\t40%\tof\tpatients\twith\ndiabetes\tand\tis\tthe\tsingle\tleading\tcause\tof\tend-stage\trenal\tdisease\t(ESRD).\tBecause\tof\tthe\tmuch\ngreater\tprevalence\tof\n\tT2DM,\tsuch\tpatients\tconstitute\tover\thalf\tof\tthe\tpatients\twith\tdiabetes
|
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0.1063690185546875,
0.06234118714928627,
0.021968210116028786,
-0.03760956972837448
] |
currently\tstarting\ton\tdialysis\t(see\t\nChapter\t34\n).\nAn\tannual\tscreening\tto\tquantitate\turine\talbumin\texcretion\trate\tshould\tbe\tperformed\tin\tpatients\nwho\thave\thad\tT1DM\tfor\tmore\tthan\t5\tyears,\tand\tin\tall\tpatients\twith\tT2DM\tstarting\tat\tdiagnosis\t(\nADA,\n2014b\n).\tThe\tserum\tcreatinine\tis\tused\tto\testimate\tglomerular\tfiltration\trate\t(GFR)\n\tand\tstage\tthe\tlevel
|
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] |
and\tstage\tthe\tlevel\nof\tchronic\tkidney\tdisease\t(CKD),\tif\tpresent.\nTo\treduce\tthe\trisk\tand\tslow\tthe\tprogression\tof\tDKD,\tblood\tglucose\tand\tblood\tpressure\tcontrol\nshould\tbe\toptimized.\tAlthough\tlow\tprotein\tdiets\t(below\t0.6\tto\t0.8\tg/kg)\thave\tbeen\tshown\tto\tlower
|
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albuminuria,\tthey\tdo\tnot\talter\tthe\tcourse\tof\tGFR\tdecline\tor\timprove\tglycemic\tor\tCVD\trisk\tmeasures,\nand\ttherefore\tare\tnot\trecommended\t(\nEvert\tet\tal,\t2013\n).\nRetinopathy\nDiabetic\tretinopathy\tis\testimated\tto\tbe\tthe\tmost\tfrequent\tcause\tof\tnew\tcases\tof\tblindness\tamong
|
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] |
adults\t20\tto\t74\tyears\tof\tage.\tGlaucoma,\tcataracts,\tand\tother\tdisorders\tof\tthe\teye\talso\toccur\tearlier\nand\tmore\tfrequently\twith\tdiabetes\t(\nADA,\t2018\n).\tLaser\tphotocoagulation\tsurgery\tcan\treduce\tthe\trisk\nof\tfurther\tvision\tloss\tbut\tusually\tdoes\tnot\trestore\tlost\tvision—thus\tthe\timportance\n\tfor\ta\tscreening\nprogram\tto\tdetect\tdiabetic\tretinopathy.
|
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] |
for\ta\tscreening\nprogram\tto\tdetect\tdiabetic\tretinopathy.\nNeuropathy\nChronic\thigh\tlevels\tof\tblood\tglucose\talso\tare\tassociated\twith\tnerve\tdamage,\tand\tan\testimated\t50%\nof\tpeople\twith\tdiabetes\thave\tmild\tto\tsevere\tforms\tof\tnervous\tsystem\tdamage\t(\nCDC,\t2018\n).\tIntensive
|
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] |
CDC,\t2018\n).\tIntensive\ntreatment\tof\thyperglycemia\treduces\tthe\trisk\tand\tslows\tprogression\tof\tdiabetic\tneuropathy\tbut\tdoes\nnot\treverse\tneuronal\tloss.\tPeripheral\n\tneuropathy\tusually\taffects\tthe\tnerves\tthat\tcontrol\tsensation\tin\nthe\tfeet\tand\thands.\tAutonomic\tneuropathy\taffects\tnerve\tfunction\tcontrolling\tvarious\torgan\tsystems.
|
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Cardiovascular\teffects\tinclude\tpostural\thypotension\tand\tdecreased\tresponsiveness\tto\tcardiac\tnerve\nimpulses,\tleading\tto\tpainless\tor\tsilent\tischemic\theart\tdisease.\tSexual\tfunction\tmay\tbe\taffected,\twith\nimpotence\tthe\tmost\tcommon\tmanifestation.\nDamage\tto\tnerves\tinnervating\tthe\tgastrointestinal\ttract\tcan\tcause\ta\tvariety\tof\tproblems.
|
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Neuropathy\tcan\tbe\tmanifested\tin\tthe\tesophagus\tas\tnausea\tand\tesophagitis,\tin\tthe\tstomach\tas\nunpredictable\temptying,\tin\tthe\tsmall\tbowel\tas\tloss\tof\tnutrients,\tand\tin\tthe\tlarge\tbowel\tas\tdiarrhea\tor\nconstipation.\nGastroparesis\n\tis\tcharacterized\tby\tdelayed\tgastric\temptying\tin\tthe\tabsence\tof\tmechanical\nobstruction
|
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0.008304379880428314,
0.06993329524993896,
0.050557930022478104,
0.02464667707681656,
0.02113480493426323
] |
obstruction\n\tof\tthe\tstomach.\tCommon\tsymptoms\tinclude\tfeelings\tof\tfullness,\tbloating,\tnausea,\nvomiting,\tdiarrhea,\tor\tconstipation.\tOne\tstudy\tfound\tthat\tthe\tprevalence\tof\tgastroparesis\tin\tpatients\nwith\tdiabetes\twas\t64%,\twhich\tis\thigher\tthan\treported\tin\tsome\tprevious\tstudies\t(\nAlipour\tet\tal,\t2017\n).
|
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] |
Alipour\tet\tal,\t2017\n).\nTherefore\tgastroparesis\tshould\tbe\tsuspected\tin\tindividuals\twith\terratic\tglucose\tcontrol.\nThe\tfirst\tstep\tin\tmanagement\n\tof\tpatients\twith\tneuropathy\tshould\tbe\tto\taim\tfor\tstable\tand\toptimal\nglycemic\tcontrol.\tMNT\tinvolves\tminimizing\tabdominal\tstress.\tSmall,\tfrequent\tmeals\tmay\tbe\tbetter
|
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] |
tolerated\tthan\tthree\tfull\tmeals\ta\tday,\tand\tthese\tmeals\tshould\tbe\tlow\tin\tfiber\tand\tfat.\tIf\tsolid\tfoods\nare\tnot\twell\ttolerated,\tliquid\tmeals\tmay\thave\tto\tbe\trecommended.\tFor\tpatients\tusing\tinsulin,\tthe\ntiming\tof\tinsulin\tadministration\n\tshould\tbe\tadjusted\tto\tmatch\tthe\tusually\tdelayed\tnutrient\tabsorption.
|
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should\tbe\tadjusted\tto\tmatch\tthe\tusually\tdelayed\tnutrient\tabsorption.\nInsulin\tinjections\tmay\teven\tbe\trequired\tafter\teating.\tFrequent\tblood\tglucose\tmonitoring\tis\timportant\nto\tdetermine\tappropriate\tinsulin\ttherapy.\nA\tprokinetic\tagent\tsuch\tas\tmetoclopramide\tis\tused\tmost\tcommonly\tto\ttreat\tgastroparesis.
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Antiemetic\tagents\tmay\tbe\thelpful\tfor\tthe\trelief\tof\tsymptoms.\tIn\tvery\tsevere\tcases,\tgenerally\twith\nunintentional\tweight\tloss,\ta\tfeeding\ttube\tis\tplaced\tin\tthe\tsmall\tintestine\tto\tbypass\tthe\tstomach.\nGastric\telectric\tstimulation\twith\telectrodes\tsurgically\timplanted\tin\tthe\tstomach\tmay\tbe\tused\twhen\nmedications\tfail\tto\tcontrol\tnausea\tand\tvomiting.
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] |
medications\tfail\tto\tcontrol\tnausea\tand\tvomiting.\nHypoglycemia\tof\tnondiabetic\torigin\nHypoglycemia\tof\tnondiabetic\torigin\n\thas\tbeen\tdefined\tas\ta\tclinical\tsyndrome\twith\tdiverse\tcauses\nin\twhich\tlow\tlevels\n\tof\tplasma\tglucose\teventually\tlead\tto\tneuroglycopenia.\tHypoglycemia\tmeans\tlow
|
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] |
(hypo-)\tblood\tglucose\t(glycemia).\tNormally\tthe\tbody\tis\tremarkably\tadept\tat\tmaintaining\tfairly\tsteady\nblood\tglucose\tlevels—usually\tbetween\t60\tand\t100\tmg/dL\t(3.3\tto\t5.6\tmmol/L),\tdespite\tthe\nintermittent\tingestion\tof\tfood.\tMaintaining\tnormal\tlevels\tof\tglucose\tis\timportant\tbecause\tbody\tcells,\nespecially\tthe\tbrain\tand\tcentral
|
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especially\tthe\tbrain\tand\tcentral\n\tnervous\tsystem,\tmust\thave\ta\tsteady\tand\tconsistent\tsupply\tof\tglucose\nto\tfunction\tproperly.\tUnder\tphysiologic\tconditions\tthe\tbrain\tdepends\talmost\texclusively\ton\tglucose\nfor\tits\tenergy\tneeds.\tThis\tis\ttrue\teven\twith\tthe\tpresence\tof\thunger.
|
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] |
Pathophysiology\nIn\ta\tsmall\tnumber\tof\tpeople,\tblood\tglucose\tlevels\tdrop\ttoo\tlow.\tSymptoms\tare\toften\tfelt\twhen\tblood\nglucose\tis\tbelow\t65\tmg/dL\t(3.6\tmmol/L).\tIf\n\tthe\tbrain\tand\tnervous\tsystem\tare\tdeprived\tof\tthe\tglucose\nthey\tneed\tto\tfunction,\tsymptoms\tsuch\tas\tsweating,\tshaking,\tweakness,\thunger,\theadaches,\tand
|
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] |
irritability\tcan\tdevelop.\tSymptoms\tof\thypoglycemia\thave\tbeen\trecognized\tat\tplasma\tglucose\tlevels\tof\nabout\t60\tmg/dL,\tand\timpaired\tbrain\tfunction\thas\toccurred\tat\tlevels\tof\tabout\t50\tmg/dL.\tA\nhypoglycemia\talert\tvalue\tgreater\tthan\tor\tequal\tto\t70mg/dL\t(3.9mmol/L)\n\tcan\thelp\tdetermine
|
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can\thelp\tdetermine\ntherapeutic\tdose\tadjustment\tof\tglucose-lowering\tdrugs\tand\tis\toften\trelated\tto\tsymptomatic\nhypoglycemia\t(\nADA,\t2018\n).\nHypoglycemia\tcan\tbe\tdifficult\tto\tdiagnose\tbecause\tthese\ttypical\tsymptoms\tcan\tbe\tcaused\tby\tmany\ndifferent\thealth\tproblems.\tFor\texample,\tadrenaline\t(epinephrine)\treleased\tas\ta\tresult\tof\tanxiety\tand
|
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] |
stress\tcan\ttrigger\tthe\tsymptoms\tsimilar\tto\tthose\tof\thypoglycemia.\n\tThe\tonly\tway\tto\tdetermine\nwhether\thypoglycemia\tis\tcausing\tthese\tsymptoms\tis\tto\tmeasure\tblood\tglucose\tlevels\twhile\tan\nindividual\tis\texperiencing\tthe\tsymptoms.\tHypoglycemia\tcan\tbest\tbe\tdefined\tby\tthe\tpresence\tof\tthree\nfeatures\tknown\tas\t\nWhipple’s\ttriad
|
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features\tknown\tas\t\nWhipple’s\ttriad\n:\t(1)\ta\tlow\tplasma\tor\tblood\tglucose\tlevel,\t(2)\tsymptoms\tof\nhypoglycemia\tat\tthe\tsame\ttime,\tand\t(3)\tresolution\tof\tthe\tsymptoms\tonce\tthe\tblood\tglucose\n\treturns\tto\nnormal.\nA\tfairly\tsteady\tblood\tglucose\tlevel\tis\tmaintained\tby\tthe\tinteraction\tof\tseveral\tmechanisms.\tAfter
|
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] |
eating,\tcarbohydrates\tare\tbroken\tdown\tinto\tglucose\tand\tenter\tthe\tbloodstream.\tAs\tblood\tglucose\nlevels\trise,\tthe\tpancreas\tresponds\tby\treleasing\tthe\thormone\tinsulin,\twhich\tallows\tglucose\tto\tleave\nthe\tbloodstream\tand\tenter\tvarious\tbody\tcells,\twhere\tit\tfuels\tthe\tbody’s\tactivities.\n\tGlucose\tis\talso
|
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] |
Glucose\tis\talso\ntaken\tup\tby\tthe\tliver\tand\tstored\tas\tglycogen\tfor\tlater\tuse.\nWhen\tglucose\tconcentrations\tfrom\tthe\tlast\tmeal\tdecline,\tthe\tbody\tgoes\tfrom\ta\tfed\tto\ta\tfasting\nstate.\tInsulin\tlevels\tdecrease,\twhich\tkeeps\tthe\tblood\tglucose\tlevels\tfrom\tfalling\ttoo\tlow.\tStored
|
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glucose\tis\treleased\tfrom\tthe\tliver\tback\tinto\tthe\tbloodstream\twith\tthe\thelp\tof\tglucagon\tfrom\tthe\npancreas.\tNormally\tthe\tbody’s\tability\n\tto\tbalance\tglucose,\tinsulin,\tand\tglucagon\t(and\tother\ncounterregulatory\thormones)\tkeeps\tglucose\tlevels\twithin\tthe\tnormal\trange.\tGlucagon\tprovides\tthe
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0.0582742802798748,
0.0997670590877533,
0.09351609647274017,
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] |
primary\tdefense\tagainst\thypoglycemia;\twithout\tit,\tfull\trecovery\tdoes\tnot\toccur.\tEpinephrine\tis\tnot\nnecessary\tfor\tcounterregulation\twhen\tglucagon\tis\tpresent.\tHowever\tin\tthe\tabsence\tof\tglucagon,\nepinephrine\thas\tan\timportant\trole.\nTypes\tof\thypoglycemia
|
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0.02890840172767639
] |
epinephrine\thas\tan\timportant\trole.\nTypes\tof\thypoglycemia\nTwo\ttypes\tof\thypoglycemia\tcan\toccur\tin\tpeople\twho\tdo\tnot\thave\tdiabetes.\tIf\tblood\tglucose\tlevels\tfall\nbelow\tnormal\tlimits\twithin\t2\tto\t5\thours\tafter\teating,\tthis\tis\t\npostprandial\t(reactive)\thypoglycemia\n.
|
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] |
postprandial\t(reactive)\thypoglycemia\n.\nIt\tcan\tbe\tcaused\tby\tan\texaggerated\tor\tlate\tinsulin\tresponse\tcaused\tby\teither\tinsulin\tresistance\tor\nelevated\tGLP-1,\talimentary\thyperinsulinism,\trenal\tglycosuria,\tdefects\tin\tglucagon\tresponse,\tor\thigh\ninsulin\tsensitivity.\tAdditionally\tit\tcan\tbe\tcaused\tby\trare\tsyndromes\tsuch\tas\thereditary\tfructose
|
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] |
intolerance,\tgalactosemia,\tleucine\tsensitivity\tor\ta\trare\tbeta-cell\tpancreatic\ttumor\t(insulinoma),\ncausing\tblood\tglucose\tlevels\tto\tdrop\ttoo\tlow.\tAlimentary\thyperinsulinism\tis\tcommon\tafter\tgastric\nsurgery,\tassociated\twith\trapid\tdelivery\tof\tfood\tto\tthe\tsmall\tintestine,\trapid\tabsorption\tof\tglucose,\tand
|
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] |
exaggerated\tinsulin\tresponse.\tThese\tpatients\trespond\tbest\tto\tmultiple,\tfrequent\tfeedings.\nThe\tingestion\tof\talcohol\tafter\ta\tprolonged\tfast\tor\tthe\tingestion\tof\tlarge\tamounts\tof\talcohol\tand\ncarbohydrates\ton\tan\tempty\tstomach\t(“gin-and-tonic”\tsyndrome)\talso\tmay\tcause\thypoglycemia\twithin\n3\tto\t4\thours\tin\tsome\thealthy\tpersons.
|
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] |
3\tto\t4\thours\tin\tsome\thealthy\tpersons.\nIdiopathic\treactive\thypoglycemia\tis\tcharacterized\tby\tnormal\tinsulin\tsecretion\n\tbut\tincreased\tinsulin\nsensitivity\tand,\tto\tsome\textent,\treduced\tresponse\tof\tglucagon\tto\tacute\thypoglycemia\tsymptoms.\tThe\nincrease\tin\tinsulin\tsensitivity\tassociated\twith\ta\tdeficiency\tof\tglucagon\tsecretion\tleads\tto
|
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] |
hypoglycemia\tlate\tpostprandially.\tIdiopathic\treactive\thypoglycemia\thas\tbeen\tinappropriately\noverdiagnosed\tby\tphysicians\tand\tpatients,\tto\tthe\tpoint\tthat\tsome\tphysicians\tdoubt\tits\texistence.\nAlthough\trare,\tit\tdoes\texist\tbut\tcan\tbe\tdocumented\tonly\tin\tpersons\twith\thypoglycemia\tthat\toccurs
|
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spontaneously\tand\tin\tpersons\twho\tmeet\tthe\tcriteria\tof\tWhipple’s\ttriad.\nFasting\thypoglycemia\n,\tor\tpostabsorptive\thypoglycemia,\toften\tis\trelated\tto\tan\tunderlying\tdisease.\nThis\tfood-deprived\thypoglycemia\tmay\toccur\tin\tresponse\tto\thaving\tgone\twithout\tfood\tfor\t8\thours\tor\nlonger\tand\tcan\tbe\tcaused\tby\tconditions
|
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longer\tand\tcan\tbe\tcaused\tby\tconditions\n\tthat\tupset\tthe\tbody’s\tability\tto\tbalance\tblood\tglucose.\tThese\ninclude\teating\tdisorders\tand\tother\tserious\tunderlying\tmedical\tconditions,\tincluding\thormone\ndeficiency\tstates\t(e.g.,\thypopituitarism,\tadrenal\tinsufficiency,\tcatecholamine\tor\tglucagon\tdeficiency),
|
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] |
acquired\tliver\tdisease,\trenal\tdisease,\tcertain\tdrugs\t(e.g.,\talcohol,\tpropranolol,\tsalicylate),\tinsulinoma\n(of\twhich\tmost\tare\tbenign,\tbut\n\t6%\tto\t10%\tcan\tbe\tmalignant),\tand\tother\tnonpancreatic\ttumors.\nTaking\thigh\tdoses\tof\taspirin\talso\tmay\tlead\tto\tfasting\thypoglycemia.\tFactitious\thypoglycemia,\tor\tself-
|
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] |
administration\tof\tinsulin\tor\tsulfonylurea\tin\tpeople\twho\tdo\tnot\thave\tdiabetes,\tis\ta\tcause\tas\twell.\nSymptoms\trelated\tto\tfasting\thypoglycemia\ttend\tto\tbe\tparticularly\tsevere\tand\tcan\tinclude\ta\tloss\tof\nmental\tacuity,\tseizures,\tand\tunconsciousness.\n\tIf\tthe\tunderlying\tproblem\tcan\tbe\tresolved,\nhypoglycemia\tis\tno\tlonger\ta\tproblem.\nDiagnostic\tcriteria
|
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] |
hypoglycemia\tis\tno\tlonger\ta\tproblem.\nDiagnostic\tcriteria\nOne\tof\tthe\tcriteria\tused\tto\tconfirm\tthe\tpresence\tof\thypoglycemia\tis\ta\tblood\tglucose\tlevel\tof\tless\tthan\n70\tmg/dL\t(3.9\tmmol/L);\thowever,\tclinically\tsignificant\thypoglycemia\t(level\t2),\tis\t54\tmg/dL\t(3.0\nmmol/L)\t(\nADA,\t2018
|
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] |
mmol/L)\t(\nADA,\t2018\n).\tPreviously\tthe\tOGTT\ttest\twas\tthe\tstandard\ttest\tfor\tthis\tcondition;\thowever,\nthis\ttest\tis\tno\tlonger\tused.\tRecording\tfinger\tstick\tblood\tglucose\tmeasurements\tduring\tspontaneous,\nsymptomatic\tepisodes\tat\thome\tis\tused\tto\testablish\tthe\tdiagnosis.\tAn\talternative\tmethod\tis\tto\tperform
|
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a\tglucose\ttest\tin\ta\tmedical\toffice\tsetting,\tin\twhich\tcase\tthe\tpatient\tis\tgiven\ta\ttypical\tmeal\tthat\thas\nbeen\tdocumented\tin\tthe\tpast\tto\tlead\tto\tsymptomatic\tepisodes.\tWhipple’s\ttriad\tcan\tbe\tconfirmed\n\tif\nsymptoms\toccur.\tIf\tblood\tglucose\tlevels\tare\tlow\tduring\tthe\tsymptomatic\tperiod\tand\tif\tthe\tsymptoms
|
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] |
disappear\ton\teating,\thypoglycemia\tis\tprobably\tresponsible.\tIt\tis\tessential\tto\tmake\ta\tcorrect\tdiagnosis\nin\tpatients\twith\tfasting\thypoglycemia\tbecause\tthe\timplications\tare\tserious.\nManagement\tof\thypoglycemia\nThe\tmanagement\tof\thypoglycemic\tdisorders\tinvolves\ttwo\tdistinct\tcomponents:\t(1)\trelief\n\tof
|
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] |
bloodstream,\tit\tincreases\tthe\tlevel\tof\tglucose\tin\tthe\tblood\tand\trelieves\tthe\tsymptoms.\tIf\tan\nunderlying\tproblem\tis\n\tcausing\thypoglycemia,\tappropriate\ttreatment\tof\tthis\tdisease\tor\tdisorder\tis\nessential.\nThe\tgoal\tof\ttreatment\tis\tto\tadopt\teating\thabits\tthat\twill\tkeep\tblood\tglucose\tlevels\tas\tstable\tas\npossible\t(\nInternational\tDiabetes\tCenter,\t2013
|
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] |
possible\t(\nInternational\tDiabetes\tCenter,\t2013\n).\tTo\tstay\tsymptom-free,\tit\tis\timportant\tfor\tindividuals\nto\teat\tfive\tto\tsix\tsmall\tmeals\tor\tsnacks\tper\tday,\tas\tthis\thelps\tto\tprovide\tmanageable\tamounts\tof\nglucose\tto\tthe\n\tbody.\tRecommended\tguidelines\tare\tlisted\tin\t\nBox\t29.8\n.\nBOX\t29.8\nGuidelines\tfor\tPreventing\tHypoglycemic\tSymptoms\tin\tPeople
|
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] |
.\nBOX\t29.8\nGuidelines\tfor\tPreventing\tHypoglycemic\tSymptoms\tin\tPeople\nWho\tDo\tNot\tHave\tDiabetes\n1.\t\nEat\tsmall\tmeals,\twith\tsnacks\tinterspersed\tbetween\tmeals\tand\tat\tbedtime.\tThis\tmeans\neating\tfive\tto\tsix\tsmall\tmeals\trather\tthan\ttwo\tto\tthree\tlarge\tmeals\tto\tsteady\tthe\trelease\tof\nglucose\tinto\tthe\tbloodstream.\n2.\t\nSpread\tthe\tintake\tof\tcarbohydrate
|
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] |
glucose\tinto\tthe\tbloodstream.\n2.\t\nSpread\tthe\tintake\tof\tcarbohydrate\n\tfoods\tthroughout\tthe\tday.\tMost\tindividuals\tcan\teat\ttwo\nto\tfour\tservings\tof\tcarbohydrate\tfoods\tat\teach\tmeal\tand\tone\tto\ttwo\tservings\tat\teach\tsnack.\nIf\tcarbohydrates\tare\tremoved\tfrom\tthe\tdiet\tcompletely,\tthe\tbody\tloses\tits\tability\tto\thandle
|
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] |
carbohydrates\tproperly,\tso\tthis\tis\tnot\trecommended.\tCarbohydrate\tfoods\tinclude\tstarches,\nfruits\tand\tfruit\tjuices,\tmilk\tand\tyogurt,\tand\tfoods\tcontaining\tsugar.\n3.\t\nAvoid\tor\tlimit\tfoods\thigh\tin\tsugar\tand\tcarbohydrate,\tespecially\ton\tan\tempty\tstomach.\nExamples\tof\tthese\tfoods\tare\tregular\tsoft\tdrinks,\tsyrups,\tcandy,\tfruit\tjuices,\tregular\tfruited
|
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] |
yogurts,\tpies,\tand\tcakes.\n4.\t\nAvoid\tbeverages\tand\tfoods\tcontaining\tcaffeine.\tCaffeine\tcan\tcause\tthe\tsame\tsymptoms\tas\nhypoglycemia\tand\tmake\tthe\tindividual\tfeel\tworse.\n5.\t\nLimit\tor\tavoid\talcoholic\tbeverages.\tDrinking\n\talcohol\ton\tan\tempty\tstomach\tand\twithout\tfood\ncan\tlower\tblood\tglucose\tlevels\tby\tinterfering\twith\tthe\tliver’s\tability\tto\trelease\tstored
|
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] |
glucose\t(gluconeogenesis).\tIf\tan\tindividual\tchooses\tto\tdrink\talcohol,\tit\tshould\tbe\tdone\tin\nmoderation\t(one\tor\ttwo\tdrinks\tno\tmore\tthan\ttwice\ta\tweek),\tand\tfood\talways\tshould\tbe\neaten\talong\twith\tthe\talcoholic\tbeverage.\nModified\tfrom\tInternational\tDiabetes\tCenter:\t\nReactive\tand\tfasting\thypoglycemia\n,\tMinneapolis,\t2013,\nInternational\tDiabetes\tCenter.
|
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] |
,\tMinneapolis,\t2013,\nInternational\tDiabetes\tCenter.\nPatients\twith\thypoglycemia\talso\tmay\tbenefit\tfrom\tlearning\tcarbohydrate\tcounting\tand,\tto\tprevent\nhypoglycemia,\teating\tthree\tto\tfour\tcarbohydrate\tservings\t(15\tg\tof\tcarbohydrate\tper\tserving)\tat\nmeals\tand\tone\tto\ttwo\tfor\tsnacks\t(see\t\nAppendix\t18\n).\tFoods\tcontaining\tprotein\tcan\tbe\teaten\tat\tmeals
|
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] |
Appendix\t18\n).\tFoods\tcontaining\tprotein\tcan\tbe\teaten\tat\tmeals\nor\twith\tsnacks.\n\tThese\tfoods\twould\tbe\texpected\tto\thave\tminimum\teffect\ton\tblood\tglucose\tlevels\tand\ncan\tadd\textra\tfood\tfor\tsatiety\tand\tcalories.\tHowever,\tbecause\tprotein\tand\tcarbohydrate\tstimulate\ninsulin\trelease,\ta\tmoderate\tintake\tmay\tbe\tadvisable.\nCLINICAL\tCASE\tSTUDY
|
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] |
CLINICAL\tCASE\tSTUDY\nMP\tis\ta\t65-year-old,\tnonsmoking\tHispanic\tfemale\twho\tis\tbeing\tseen\tfor\tmanagement\tof\ttype\t2\ndiabetes.\tHer\tblood\tglucose\tlevels\tare\tuncontrolled\n\tas\tevidenced\tby\tan\tA1C\t>\t10,\tand\tshe\ncomplains\tof\tincreasing\tnumbness\tin\ther\tfeet\tand\toccasionally\tin\ther\tfingers,\tand\tfrequent
|
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urination\tduring\tthe\tday\tand\tovernight.\tFrom\tinterviewing\ther\tand\treviewing\ther\thealth\trecord,\nyou\tlearn\tthe\tfollowing\tabout\ther:\nEducation:\tdid\tnot\tcomplete\thigh\tschool,\tattended\tthrough\tmiddle\tschool.\nOccupation:\tnot\temployed\toutside\tthe\thome,\tbabysits\tinfant\tgrandchild\n\ton\ta\tdaily\tbasis.
|
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on\ta\tdaily\tbasis.\nHousehold\tMembers:\tlives\twith\ther\thusband\tand\twith\tone\tof\ther\tfour\tadult\tchildren.\nEthnic\tBackground:\tLatin\tAmerican,\tborn\tin\tMexico,\temigrated\tto\tthe\tUnited\tStates\tin\t1980.\nReligious\tAffiliation:\tCatholic.\nLanguage:\tNative\tSpanish,\tspeaks\tEnglish—has\tdifficulty\treading\tEnglish.\nPatient\tHistory:\tWeighed\tmore\tthan\t9\tlb\tat\tbirth.
|
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] |
Patient\tHistory:\tWeighed\tmore\tthan\t9\tlb\tat\tbirth.\nMP\twas\tdiagnosed\twith\tT2DM\t10\tor\t15\tyears\n\tago\tand\ther\tdiabetes\tmanagement\thistory\tis\tas\nfollows:\nType\tof\tTreatment:\tNutrition\ttherapy\tplus\toral\tdiabetes\tmedication\tand\tlong-acting\tinsulin\tat\nbedtime\t(HS)\nMedications:\tglargine\t80\tunits\tat\tHS,\tmetformin\tXR\t1000\tmg\tBID,\tenalapril\t10\tmg\tdaily,
|
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] |
simvastatin\t40\tmg\tdaily,\tlevothyroxine\t75\tmcg\tdaily\nFamily\tHistory:\tMother\thad\ttype\t2\tdiabetes,\t12-year-old\tgrandson\trecently\tdiagnosed\twith\nprediabetes\nMedical\tHistory:\ttype\t2\tdiabetes,\thypertension,\thyperlipidemia,\thypothyroidism,\tepisodic\nmigraines\t(last\toccurrence\t2017)\nPhysical\texamination\tshows\tthe\tfollowing:\nWeight:\t201\tlbs.\nHeight:\t5’2”.
|
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] |
Weight:\t201\tlbs.\nHeight:\t5’2”.\nTemperature:\t98.6°F\nBlood\tPressure:\t143/88\tmm\tHg\nHeart\tRate:\t80\tbpm\nLaboratories:\tA1C\t10\nNutrition\tdiagnostic\tstatement\n•\t\nAltered\tblood\tglucose\tlevels\trelated\tto\tdifficulty\n\tmatch\tinsulin\tto\tcarbohydrate\tintake\tas\nevidenced\tby\texcessive\tmealtime\tcarbohydrate\tintake\tand\televated\tpostprandial\tself-
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monitoring\tof\tblood\tglucose\t(SMBG)\tdownload\tdata\treport.\nInterventions\n•\t\nFor\teach\tof\tthe\ttwo\tproblem,\tetiology,\tand\tsigns\tand\tsymptoms\t(PES)\tstatements,\twrite\ta\ngoal\tbased\ton\tsigns\tand\tsymptoms.\n•\t\nFor\tthe\ttwo\tgoals,\twrite\ttwo\tto\tthree\tnutrition\tinterventions\tbased\n\ton\tthe\tetiology\tthat\twould\nbe\tappropriate\tfor\tMP.
|
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on\tthe\tetiology\tthat\twould\nbe\tappropriate\tfor\tMP.\nNOTE:\tIn\ta\treal\tface-to-face\tappointment\tbetween\ta\tregistered\tdietitian\tnutritionist\t(RDN)/\nCertified\tDiabetes\tEducator\t(CDE)\tand\tMP,\tthey\twould\tcollaboratively\tdevelop\ther\tgoals\ttogether.\nEvaluation\tand\tmonitoring\n•\t\nWhen\tshould\tthe\tnext\tnutrition\tcounseling\tsession\tbe\tscheduled\tfor\tMP?\n•
|
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•\t\nWhat\twould\tyou\tassess\tat\tthe\tfollow-up\tvisit\n\tbased\ton\tthe\tnutrition\tgoals\tand\tinterventions\ndeveloped\tat\tthe\tinitial\tappointment?\nUseful\twebsites\nAcademy\tof\tNutrition\tand\tDietetics\t(AND)\nAcademy\tof\tNutrition\tand\tDietetics\tEvidence\tAnalysis\tLibrary\nAmerican\tAssociation\tof\tDiabetes\tEducators\t(AADE)\nAmerican\tDiabetes\tAssociation\t(ADA)
|
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American\tDiabetes\tAssociation\t(ADA)\nDiabetes\tCare\tand\tEducation\tPractice\tGroup\t(DCE)\nDCE\tPatient\tEducation\tHandouts\nInternational\n\tDiabetes\tCenter\t(IDC)\nIDC\tPublishing\nJoslin\tDiabetes\tCenter\nNational\tDiabetes\tEducation\tProgram\t(NDEP)\nNational\tInstitute\tof\tDiabetes\tand\tDigestive\tKidney\tDiseases\t(NIDDK)\nResources\tfor\tHealthcare\tProfessionals
|
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Resources\tfor\tHealthcare\tProfessionals\nPortions\tof\tthis\tchapter\twere\twritten\tby\tMarion\tJ\tFranz,\tMS,\tRDN,\tLD,\tCDE\tand\tAlison\tB\tEvert,\tMS,\tRDN,\nCDE\tfor\tthe\tprevious\tedition\tof\tthis\ttext.
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30\nMedical\tnutrition\ttherapy\tfor\nthyroid,\tadrenal,\tand\tother\nendocrine\tdisorders\nSheila\tDean,\tDSc,\tRDN,\tLDN,\tCCN,\tIFMCP\nKEY\tTERMS\n5-deiodinase\nAddison’s\tdisease\nadrenal\tfatigue\nautoimmune\tthyroid\tdisorders\t(AITDs)\ncalcitonin\ncortisol\ncretinism\neuthyroid\tsick\tsyndrome\nfree\tT\n4\ngoitrin\nGraves’\tdisease\nHashimoto’s\tthyroiditis\nhyperthyroidism
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] |
4\ngoitrin\nGraves’\tdisease\nHashimoto’s\tthyroiditis\nhyperthyroidism\nhypothalamic-pituitary-thyroid\n\taxis\t(HPT\taxis)\nhypothalamus\nhypothyroidism\npituitary\tgland\npolycystic\tovary\tsyndrome\t(PCOS)\nreverse\tT\n3\n\t(rT\n3\n)\nSchmidt’s\tsyndrome\nthyroglobulin\tantibodies\t(TGB\tAb)\nthyroid-binding\tglobulin\t(TBG)\nthyroid\tperoxidase\t(TPO)
|
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] |
thyroid-binding\tglobulin\t(TBG)\nthyroid\tperoxidase\t(TPO)\nthyroid\tperoxidase\tantibodies\t(TPO\tAb)\nthyroid-stimulating\thormone\t(TSH)\nthyrotoxicosis\nthyrotropin-releasing\thormone\t(TRH)\nthyroxine\t(T\n4\n)\ntriiodothyronine\t(T\n3\n)\ntyrosine\nDiabetes\tmellitus\tis\tthe\tmost\tcommon\tendocrine-related\tchronic\tdisease\t(\nCenters\tfor\tDisease
|
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Centers\tfor\tDisease\nControl\tand\tPrevention\t[CDC],\t2018\n;\t\nNational\tInstitutes\tof\tHealth\t[NIH]\tMedlinePlus,\t2018\n).\nHowever,\taccording\tto\ta\tcomprehensive\treview\tof\tthe\tprevalence\tand\tincidence\tof\tendocrine\tand\nmetabolic\tdisorders\tin\tthe\tUnited\tStates\t(2009),\tabout\t5%\tof\tthe\tU.S.\tpopulation\tage\t12\tand\tolder\nhas\thypothyroidism,
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] |
has\thypothyroidism,\n\tand\tmore\tthan\thalf\tremain\tundiagnosed.\tFurthermore,\tindividuals\twith\tdiabetes\ntend\tto\thave\ta\thigher\tprevalence\tof\tthyroid\tdisorders.\tAccording\tto\tNational\tHealth\tand\tNutrition\nExamination\tSurvey\t(NHANES)\tdata,\tthe\tlargest\tcommunity-based\tstudy\tof\tthyroid\tfunction\tin\tthe
|
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] |
United\tStates,\tthe\tprevalence\tof\thigh\tserum\tthyroid-stimulating\thormone\t(a\tmarker\tfor\nunderfunctioning\tthyroid)\twas\n\t2%\tin\tpeople\taged\t60\tto\t69\tyears,\t6%\tin\tthose\taged\t70\tto\t79\tyears,\nand\t10%\tin\tthose\taged\t80\tyears\tand\tolder\t(\nHollowell\tet\tal,\t2002\n).
|
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] |
In\tan\tanalysis\tthat\texamined\tthyroid\tdisease\trisk\tamong\tmultiple\tethnicities\tin\tthe\tU.S.\tmilitary,\nthe\tincident\trate\tfor\tthyroid\tdisease,\tspecifically\tGraves’\tdisease\t(autoimmune\thyperthyroid),\twas\nsignificantly\thigher\tamong\tblacks\tand\tAsian/Pacific\tIslanders.\tThe\n\tincidence\tof\tautoimmune
|
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] |
incidence\tof\tautoimmune\nhypothyroid,\tHashimoto’s\tthyroiditis,\twas\thighest\tin\twhites\tand\tlowest\tin\tblacks\tand\tAsian/Pacific\nIslanders\t(\nMcLeod\tet\tal,\t2014\n).\nIn\ta\tstudy\tthat\texamined\tgender,\trace,\tand\tsocioeconomic\tinfluence\ton\tdiagnosis\tand\ttreatment\tof\nthyroid\tdisorders\tin\tBrazilians,\tfrequency\tof\thypothyroidism\ttreatment\twas\thigher\tin\twomen\tand
|
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] |
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